Nutrition Assistance Program Report Series
The Office of Analysis, Nutrition and Evaluation
Special Nutrition Programs
Report No. WIC-02-NAM
The Characteristics of Native
American WIC Participants, On
and Off Reservations
United States
Department of
Agriculture
Food and
Nutrition
Service
May 2002
“The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of
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To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building,
14th and Independence Avenue, SW, Washington, DC 20250-9410 or call (202) 720-5964 (voice and TDD). USDA is
an equal opportunity provider and employer.
United States
Department of
Agriculture
Food and
Nutrition
Service
May 2002
Special Nutrition Programs
Report No. WIC-02-NAM
The Characteristics of Native
American WIC Participants,
On and Off Reservations
Author:
Nancy Cole
Submitted by:
Abt Associates, Inc
55 Wheeler Street
Cambridge, MA 02138
Submitted to:
Office of Analysis, Nutrition and Evaluation
Food and Nutrition Service, USDA
3101 Park Center Drive
Alexandria, VA 22302-1500
Project Officer: Sheku G. Kamara, Ph.D.
This report is available on the Food and Nutrition Service web site:
http://www.fns.usda.gov/oane.
Suggested Citation:
U.S. Department of Agriculture, Food and Nutrition Service, Office of Analysis, Nutrition and
Evaluation “The Characteristics of Native American WIC Participants, On and Off Reservations”
Nutrition Assistance Program Report Series, NO. WIC-02-NAM, by Nancy Cole. Project Officer,
Sheku G. Kamara, Ph.D., Alexandria, VA, 22302.
ACKNOWLEDGEMENTS
This report benefits from the review of several staff in the Office of Analysis, Nutrition
and Evaluation (OANE) Food and Nutrition Service, U.S. Department of Agriculture. At
Abt Associates, Mary Kay Fox provided thoughtful review and comments on drafts. The
author thanks Dr. Sheku G. Kamara, the project officer, for guiding the report to
completion.
Contents
Executive Summary .............................................................................................................iii
1. Introduction......................................................................................................................1
2. Native American Tribes and Their Role in the WIC Program ..........................................3
Locations of State WIC ITOs ......................................................................................3
Local Agency WIC ITOs ............................................................................................6
Distribution of Total Native American WIC Enrollment................................................6
3. Demography of Native Americans ...................................................................................10
Enumerating the Population ...................................................................................... 10
Geographic Distribution of Native Americans ............................................................ 11
Economic Conditions ................................................................................................ 12
Public Health Concerns............................................................................................. 14
4. Characteristics of Native American WIC Participants, On and Off Reservations ...........16
WIC Caseload Trends ............................................................................................... 16
Geographic Distribution of Native American WIC Participants.................................... 18
Demographics of Native American WIC Participants .................................................. 20
5. Prevalence of Nutrition Risks in Native American WIC Participants..............................26
Reporting of Nutrition Risks...................................................................................... 26
Prevalence of Risks .................................................................................................. 28
Prevalence of Overweight in WIC Children................................................................ 31
6. Conclusion......................................................................................................................35
References...........................................................................................................................36
Appendix Exhibits ..............................................................................................................38
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Characteristics of Native American WIC Participants
i
List of Exhibits
Exhibit 1
Native American Enrollment at State WIC Programs Operated by Indian Tribal
Organizations
Exhibit 2
Locations of Federally Recognized American Indian Reservations
Exhibit 3
Native American Population of States, 1990
Exhibit 4
Distribution and Concentration of Native American WIC Enrollment by Tribal
Affiliation of WIC Agencies, 1998
Exhibit 5
Prevalence of Poverty in Decennial Census Years, By Race
Exhibit 6
Selected Characteristics of Native American Pregnancies and Births, 1994-96
Exhibit 7
Native American WIC Enrollment, 1992 - 1998
Exhibit 8
Distribution of Native American WIC Enrollment by Tribal Affiliation of Certifying
Agency
Exhibit 9
Distribution of Native American WIC Enrollment by Proximity to Reservations
Exhibit 10a Regional and Metropolitan Distribution of Native American WIC Enrollment, By
Location on Reservation Lands, 1998
Exhibit 10b Percent of Native American WIC Enrollment On or Near a Reservation, By FNS
Region, 1998
Exhibit 11 Distribution of Age at Certification of Native American WIC Enrollees, 1998
Exhibit 12 Demographic Characteristics of Native American WIC Enrollees, 1998
Exhibit 13 State Agency Policies for Recording Nutrition Risks at Certification
Exhibit 14 Percent of WIC Enrollees with More than One Nutrition Risk Present at Certification
Exhibit 15 Prevalence of Reported Nutrition Risks among Native American WIC Women and
All WIC Women, 1998
Exhibit 16 Prevalence of Reported Nutrition Risks among Native American WIC Women, By
Certification Category, 1998
Exhibit 17 Prevalence of Reported Nutrition Risks among WIC Infants and Children, 1998
Exhibit 18 Percent of Native American WIC Children Measured Overweight, By Age and
Gender, 1998
Appendix Exhibits
Exhibit A.1 Geographic Jurisdictions of Indian Tribal Organizations Administering State WIC
Programs
Exhibit A.2 Geographic Jurisdictions of Indian Tribal Organizations Administering WIC
Programs: East and Southeastern United States
Exhibit A.3 Geographic Jurisdictions of Indian Tribal Organizations Administering WIC
Programs: Midwest and Western United States
Exhibit A.4 Geographic Jurisdictions of Indian Tribal Organizations Administering WIC
Programs: Southwestern United States
ii
Characteristics of Native American WIC Participants
Abt Associates Inc.
Executive Summary
This study describes Native American participation in the WIC Program. The study is based on data
collected by the biennial WIC Participant and Program Characteristics Studies in 1992, 1994, 1996,
and 1998.
WIC is the Special Supplemental Nutrition Program for Women, Infants, and Children. This Federal
program, administered by USDA, provides supplemental foods, nutrition education, and health care
referrals to pregnant and postpartum women, infants, and children up to age 5.
Native American WIC Enrollment
In 1998, the WIC Program served 121,000 Native American women, infants, and children.
Approximately 48 percent of all Native American infants and children under age 5, and 65 percent of
all Native American pregnant women, were enrolled in WIC. Native American WIC enrollment
increased 17 percent between 1992 and 1998, while overall WIC enrollment grew by more than twice
that amount (40 percent).
Native American Tribes Operating WIC Agencies
Federally recognized Native American tribal governments may operate WIC agencies at either the
State or local level. In 1998, 33 Indian tribes or Indian Tribal Organizations (ITOs) operated state
WIC agencies (up from 30 in 1992), and an additional 56 tribes or ITOs operated local WIC agencies.
In 1998, 41 percent of Native American WIC enrollment was at state WIC agencies operated by tribal
governments; an additional 17 percent was at tribal local WIC agencies administered by non-tribal
States. The growth in Native American WIC enrollment, from 1992 to 1998, varied greatly by type
of agency: enrollment at tribal state WIC agencies was virtually unchanged, enrollment at tribal local
WIC agencies increased by 19 percent, and enrollment at non-tribal agencies increased by 40 percent
(matching the growth in the overall WIC caseload). Tribal WIC agencies are located on or near
reservations, whereas non-tribal local WIC agencies enrolling Native Americans are located, on
average, 111 miles from the nearest American Indian reservation.
Characteristics of Native American WIC Participants
The regional and metropolitan/non-metropolitan distribution of Native American WIC enrollment
corresponds to the overall distribution of the Native American population. Native Americans are
highly concentrated in the West, Southwest, and Mountain Plains regions (which contain 82 percent
of all Native American WIC enrollees); 62 percent of Native American WIC enrollees reside in nonmetropolitan areas. In 1998, 63 percent of Native American WIC enrollees lived on or near
reservations and 75 percent lived in areas served by tribal governments.1
Compared to all WIC enrollees, Native American WIC enrollees have larger average family size (4.2
versus 3.9 persons) and are more likely to receive public assistance. The percentage of Native
1
Location of WIC enrollees on or near tribal lands is based on the geographic service area of local WIC agencies; data
from the WIC Participant and Program Characteristics Studies do not include individual WIC enrollee address
information. Areas served by tribal governments include Oklahoma Tribal Jurisdiction Statistical Areas (TJSAs).
Abt Associates Inc.
Characteristics of Native American WIC Participants
iii
American WIC enrollees receiving TANF is 21.1 versus 17.0 percent of all WIC enrollees; 41.6
percent of Native American WIC enrollees receive food assistance from the Food Stamp Program or
Food Distribution Program on Indian Reservations, compared to 26.6 percent of all WIC enrollees.
The distribution of Native American WIC enrollees with respect to the poverty guidelines, however,
does not differ substantially from all WIC enrollees.
Characteristics of Native American WIC Participants On Versus Off Reservations
In many ways, the 63 percent of Native American WIC enrollees located on or near Indian
reservations differ substantially from Native American WIC enrollees residing off reservations. WIC
enrollees located on or near reservations are highly concentrated in the West (61 percent) and
Mountain Plains (20 percent), while those off reservation are most concentrated in the Southwest (44
percent). Those located off reservation are more likely to reside in metropolitan areas (45.7 versus
33.4 percent).
Compared to Native American WIC enrollees off reservations, those on or near reservations have
larger average family size (4.4 versus 4.0) and are more likely to be in families of six or more persons
(23.8 versus 14.0 percent). Those on or near reservations also have greater participation in public
assistance programs (24.6 versus 15.2 percent receive TANF; 39.4 versus 29.5 receive food
assistance) and more severe poverty (41.4 versus 34.9 are below 50% of the federal poverty level).
Prevalence of Nutrition Risks in Native American WIC Participants
Applicants to the WIC program must demonstrate nutritional risk, defined by detrimental or abnormal
nutritional conditions detectable by biochemical or anthropometric measurements; nutritionally
related medical conditions; die tary deficiencies; or conditions that predispose persons to inadequate
nutritional patterns. The number of nutrition risks recorded in WIC information systems varies
somewhat by agency. Native American WIC enrollees, in all participant categories, have a greater
number of nutrition risks than the overall WIC caseload and exhibit higher risk prevalence in most of
the major categories of risk.
Native American women enrolled in WIC have greater risk prevalence than all WIC women in all
risk categories except biological risks. The comparison of Native American women on and off
reservations, however, shows no clear pattern: those living on or near reservations have a higher
recorded prevalence of anthropometric risks and some clinical risks, while Native American women
living off reservations have a higher recorded prevalence of biological risks and some clinical risks.
Native American infants have greater risk prevalence, compared to all WIC infants, in each of the
major risk categories. Infants living on reservations, compared to those off reservations, have higher
prevalence of clinical risks (22.2 versus 12.5 percent) and dietary risks (19.2 versus 12.3 percent),
while infants off reservations have a slightly higher rate of anthropometric risks (28.9 versus 27.5
percent).
Native American children have greater risk prevalence than all WIC children in all risk categories
except biological risks and show much the same pattern as infants in risk differences according to
location on or near reservations. In addition, Native American WIC children have higher rates of
overweight prevalence than all WIC children: overweight prevalence is 20 percent for Native
American children on or near reservations, 16 percent for Native American children off reservations,
and 13 percent for all WIC children.
iv
Characteristics of Native American WIC Participants
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1.
Introduction
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is designed to
prevent the occurrence of health problems and improve health status for pregnant women, postpartum
women, infants, and children up to age five. WIC acts as an adjunct to good health by providing
supplemental foods, nutrition education, and health care referrals.2 Throughout its history, the WIC
program has served a large percentage of Native American women, infants, and children. This report
examines the characteristics of Native Americans enrolled in the WIC Program, compares the
characteristics of Native American WIC enrollees to the overall population of WIC enrollees, and
compares Native Americans residing on or near reservations with those not near reservations.
Researchers contend that we know less about the current demographic and health situation of Native
Americans than that of other racial or ethnic groups (Sandefur, 1996). This lack of knowledge is
primarily due to the fact that the Native American population is the smallest of the major racial
groups counted by the U.S. Census: in 1990, 1.9 million Native Americans accounted for less than
one percent of the U.S. population. 3 Because of the small size of the Native American population,
national population surveys do not yield sufficient samples for study. Moreover, the geographic
dispersion of many small Native American tribal entities makes targeted surveys of Native Americans
costly. 4
The WIC program currently serves 120,000 Native American women, infants, and children. In 1998,
approximately 48 percent of all Native American infants and children under age 5, and 65 percent of
all Native American pregnant women, were enrolled in WIC.5,6 With a high percentage of Native
Americans participating in the WIC program, it is clear that WIC data can contribute to our
understanding of the characteristics of low-income Native Americans.
2
The purpose and role of the WIC Program, as stated here, is taken from federal regulations (7 CFR 246.1).
3
Native Americans include American Indians, Eskimos, and Aleuts. The 1990 Census counted 1.88 million American
Indians; 57,000 Eskimos; and 24,000 Aleuts. Census 2000 results are presented in section 3 of this report.
4
See Erickson, Eugene. "Problems in Sampling the Native American and Alaska Native Populations." Chapter 6 in
Sandefur (1996).
5
In 1998, the number of Native American infants and children enrolled in WIC was 95,697 (PC98); the estimated
number of Native Americans under age five years in the United States was 200,000 (US Bureau of the Census.
Projections of the Total Resident Population by 5-Year Age Groups, Race, and Hispanic Origin with Special Age
Categories: Middle Series, 1999 to 2000). The number of pregnant women in WIC in April 1998 was 12,506; the
number of live births to Native American women in 1997 (the most recent data available) was 38,572; assuming an
average WIC participation spell of six months for pregnant women yields the estimated 65 percent participation rate.
6
These figures are gross participation rates measured by the number of WIC enrollees as a percent of the total
population, not as a percent of the income-eligible population. The income-eligible population of Native Americans
can be accurately measured only in Census years.
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Characteristics of Native American WIC Participants
1
On a biennial basis, since 1992, the WIC program has collected administrative data for nearly all
persons enrolled in WIC during the reference month of April. These data, known as "PC" data,
include much of the information collected during the WIC certification process: demographic
information, economic indicators determining WIC income eligibility, and indicators of health and
nutrition status.7 While WIC data cannot provide a comprehensive base for studying the overall
population of Native Americans, it provides detailed data for examining the geographic distribution,
demographic characteristics, and health status of low-income Native American women and children. 8
The next section of this report reviews the role of Native American tribes in administering the WIC
program and provides information about the numbers and locations of Native American tribes in the
United States. Section three provides an overview of American Indian demography and public health
concerns. Section four describes the demographic characteristics of Native American WIC enrollees
and compares characteristics of subgroups of Native Americans according to residence on or off
reservation lands. Characteristics of Native American WIC enrollees are also compared with overall
WIC enrollment. Section five examines the health status of Native American WIC enrollees as
reflected in the nutrition risks observed at the time of WIC certification, and section 6 concludes the
report.
7
The U.S. Department of Agriculture, Food and Nutrition Service (FNS) administers the WIC Program. The PC data
are collected and tabulated for the biennial reports: WIC Participant and Program Characteristics.
8
Applicants to WIC must be income eligible and have nutritional need. Income eligibility is defined by income below
185 percent of the federal poverty guidelines or participation in the Food Stamp, TANF, or Medicaid programs.
Nutritional need may be indicated by presence of nutritional risk in one of five major categories (anthropometric,
biochemical, clinical/medical, dietary, and predisposing).
2
Characteristics of Native American WIC Participants
Abt Associates Inc.
2.
Native American Tribes and Their Role in the WIC Program
The WIC program is administered by the Food and Nutrition Servic e (FNS) of the U.S. Department
of Agriculture (USDA). FNS provides cash grants to State agencies, which develop policies and
procedures for administering the program within federal guidelines. In 1998, 88 State agencies
operated WIC programs: the 50 US States, the District of Columbia, four outlying territories,9 and 33
Indian Tribal Organizations (ITOs).
Federal WIC regulations allow two types of Indian Tribal Organizations (ITOs) to operate as State
agencies (7 CFR 246.2):
§
An Indian tribe, band or group recognized by the Department of the Interior.
§
An intertribal council or group which is an authorized representative of Indian tribes, bands
or groups recognized by the Department of the Interior and which has an ongoing relationship
with such tribes, bands, or groups for other purposes and has contracted with them to
administer the Program.
The role of Tribal governments within the WIC Program is equivalent to State governments. Indian
Tribal Organizations operate WIC agencies and administer the WIC program within tribal
jurisdictions. This role of ITOs is not unique to the WIC Program; the Self Determination and
Education Assistance Act of 1975 gave tribal governments authority to contract with the federal
government to regulate federal programs within tribal jurisdictions.
Locations of State WIC ITOs
The 33 Indian Tribal Organizations (ITOs) operating as State WIC agencies in 1998 were all located
in the mainland United States. State WIC ITOs consisted of 22 individual tribes, 4 inter-tribal
councils, and 7 groups of tribes residing near each other. Together, the WIC ITOs represent nearly
100 tribes, from among the 385 federally recognized American Indian tribes or tribal organizations
located in the mainland and identified by the United States Department of the Interior, Bureau of
Indian Affairs. 10 (The Bureau of Indian Affairs also recognizes 224 Alaska Native Villages.)
Exhibit 1 lists all Indian Tribal Organizations (ITOs) operating State WIC agencies at any time during
the period 1992 to 1998. The number of WIC ITOs has remained relatively constant during the
9
The outlying territories are American Samoa, Guam, Puerto Rico, and the U.S. Virgin Islands.
10
The count of tribes is from the Indian Lands and Native Entities in the United States database obtained from the
Geospatial Data Clearinghouse, United States Department of Interior, Bureau of Indian Affairs, 2000. All counts of
American Indian tribes and tribal lands in this section are limited to the mainland United States and do not include
Alaskan Native Villages.
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Characteristics of Native American WIC Participants
3
Exhibit 1
Native American Enrollment at State WIC Programs Operated by Indian Tribal Organizations
1992
Arizona
Inter Tribal Council of Arizona (20)
Navajo Nation
Colorado
Ute Mountain Ute
Florida
Seminole Tribe
Maine
Indian Township
Pleasant Point
Mississippi
Mississippi Choctaw
Nebraska
Nebraska Indian Inter-tribal Development Corp. (4)
Omaha and Santee Tribes (2)
Nevada
Inter Tribal Council of Nevada (24)
New Mexico
ACL: Acoma, Canoncita, Laguna Pueblos (3)
Eight Northern Pueblos (8)
Pueblo of Isleta
Pueblo of San Felipe
Five Sandoval Pueblos (5)
Santo Domingo
Pueblo of Zuni
New York
Seneca Nation
North Carolina
Eastern Band of Cherokee
North Dakota
Standing Rock Sioux
Three Affiliated Tribes: Arikara, Hidasta, Mandan (3)
Oklahoma
Inter Tribal Council of Oklahoma
Cherokee Nation
Muscogee Creek Nation
Otoe-Missouria
Osage Nation
Citizen Band of Potawatomi
Chickasaw Nation
Sac and Fox Nation
Choctaw Nation
WCD: Wichita, Caddo, Delaware Tribes (3)
South Dakota
Cheyenne River Sioux
Rosebud Sioux
Wyoming
Shoshone and Arapahoe Tribes (2)
WIC Participation
1994
1996
1998
Percent
Change
1992-98
6,223
17,856
8,332
19,379
8,177
18,221
8,156
15,844
31.1
-11.3
180
174
166
165
-8.3
189
171
106
na
na
71
115
99
98
100
82
91
79
28.2
-31.3
691
628
622
681
-1.4
611
na
641
na
742
na
243
436
-60.2
na
889
784
711
851
-4.3
567
484
495
339
425
322
821
591
520
410
326
541
359
865
714
467
384
252
418
326
918
534
371
295
344
369
231
846
-5.8
-23.3
-40.4
1.4
-13.3
-28.3
3.0
295
275
266
266
-9.8
734
510
723
632
-13.9
1,187
596
1,069
558
1,071
514
901
427
-24.1
-28.4
300
6,077
na
718
na
990
1,147
na
1,790
1,914
263
6,382
na
688
na
1,121
1,312
na
1,772
1,942
314
6,645
539
462
7
1,097
1,633
146
1,632
2,015
297
6,582
729
495
479
780
1,593
219
1,737
2,147
-1.0
8.3
na
-31.1
na
-21.2
38.9
na
-3.0
12.2
712
1,576
686
1,520
729
1,479
723
1,380
1.5
-12.4
822
858
800
763
-7.2
Total Native American enrollment at ITOs
49,136
52,874
52,478
49,686
Total Native American enrollment in WIC
103,245
116,916
122,849
121,140
Percent of enrollment at ITO State agencies
47.6
45.2
42.7
41.0
NOTE: Numbers in parentheses are the number of tribes represented by the ITO, when more than one.
1.1
17.3
4
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1990s. Only one ITO ceased operating as a State WIC agency (Seminole Tribe in Florida), while four
tribes began WIC operations during this time period. Exhibit 1 shows WIC enrollment at each ITO
for each year of WIC data collection, and the percentage change in enrollment from 1992 to 1998.
Total Native American WIC enrollment grew 17.3 percent during this time period (see bottom of
exhibit), but the change in enrollment at individual ITOs was highly variable.11
WIC ITOs are among the largest tribal organizations in the United States, accounting for roughly
two-thirds of Native Americans living on reservations and three-fourths of Native Americans living
within tribal jurisdictions. (The geographic jurisdictions and population of tribes operating WIC
ITOs is shown in Appendix Exhibit 1.) The Cherokee and Navajo Tribes account for 45 percent of
Native American WIC participants enrolled through ITO State WIC agencies (see Exhibit 1).
According to the 1990 Census, the Cherokee and Navajo account for 30 percent of American Indians
(Bureau of Census, 1994).12 The Cherokee tribe is the largest tribe with a population over 300,000.
The greatest concentration of Cherokee (36 percent) resides in Oklahoma where two federally
recognized Cherokee tribes reside without land bases.13 In contrast, nearly two-thirds of the 225,000
Navajo reside in the Southwest where the Navajo Nation maintains the largest Indian land base in the
United States, spanning portions of Arizona, New Mexico, and Utah.
WIC ITOs are located in 13 States. All WIC ITOs, except those in Oklahoma, are associated with
federally recognized American Indian Reservations. American Indian Reservations (AIRs) are
recognized and established by federal treaty or statute as lands set aside for the use of Indians. 14 The
Osage Nation is the only WIC ITO in Oklahoma with a federally recognized AIR; the remaining
Oklahoma WIC ITOs have trust lands (no formal reservation), or lack a land base but nonetheless
provide benefits and services to members of their tribes. 15,
11
There are no available data to explain the varying changes in enrollment across ITOs. USDA, Food and Nutrition
Service conducts a survey of State WIC Programs in each year of biennial data collection, but survey questions focus
on administrative procedures and do not capture information to explain fluctuating caseloads.
12
In 1990, ten tribes accounted for 60 percent of American Indians residing in the United States, although the total
population of these individual tribes may consist of several subtribes associated with different reservations. Tribal
statistics from the Bureau of Census are based on self-reported tribal identification recorded on Census forms. These
statistics do not necessarily coincide with statistics based on tribal membership rolls reported by tribal governments or
the Bureau of Indian Affairs. Population totals include persons residing off reservations.
13
The two federally recognized Cherokee tribes in Oklahoma are the Cherokee Nation and United Band of Cherokee
Indians of Oklahoma. (Federal Register, Vol. 65, No. 49, March 13, 2001.)
14
The Bureau of Census identifies 309 federally recognized American Indian Reservations in the year 2000 geographic
TIGER data.
15
Trust lands are owned by the federal government and held in trust for the benefit of Indians. Many Oklahoma
reservations were allotted to individual tribal members prior to Oklahoma statehood, with allotments eventually
converted to individual ownership. Information about Indian lands is available in the compendium “American Indian
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Characteristics of Native American WIC Participants
5
Exhibit 2 shows the locations of all federally recognized American Indian Reservations within
mainland United States. Reservations are located in 35 States. The 13 States where WIC ITOs are
located are shown with dark shading, and remaining States with reservations are shown with lighter
shading. The heaviest concentrations of tribal lands are in the Southwest and West. (See Appendix
exhibits for maps showing reservation boundaries of WIC ITOs.)
The distribution of the Native American population is shown in Exhibit 3. In 1990, 24 percent of
Native Americans lived on reservations and trust lands, and a total of 37 percent lived within the
boundaries of areas served by tribal governments (Snipp, 1996). A comparison of Exhibits 2 and 3
shows that the regional distribution of the Native American population coincides with locations of
tribal lands, with the exception of Oklahoma. The similarity in the patterns of the maps shown in
Exhibits 2 and 3 demonstrates that, even though only 24 percent of Native Americans reside on
reservations, the largest concentrations of Native Americans are found in relative proximity to
reservation lands.
Local agency WIC ITOs
In addition to the 33 ITOs administering WIC programs at the State agency level in 1998, 56 Indian
tribes or tribal councils operated local WIC agencies. Local WIC agencies administer service sites
where applicants are certified and program benefits are disbursed. Local agencies operate under the
jurisdiction of State agencies. In the 50 US States, "State WIC agencies" are operated by State
departments of health. Local agencies are often county departments of health, but may also be private
non-profit health or human service agencies contracting with the State WIC agency, or Indian tribes
or tribal councils.16
Distribution of Total Native American WIC Enrollment
Exhibit 4 summarizes the distribution and concentration of Native American WIC enrollment by
tribal affiliation of WIC agency. In 1998, 41 percent of Native American WIC enrollment was at 59
local WIC agencies operated by 33 Indian Tribal Organizations (ITOs). An additional 17 percent of
Native American WIC enrollment was at 56 local WIC agencies operated by tribal entities under the
Reservations and Trust Areas” compiled by the U.S. Department of Commerce, Economic Development
Administration.
16
6
Tribal local WIC agencies were identified in WIC data by agency name; FNS does not collect data on the sponsorship
of local WIC agencies.
Characteristics of Native American WIC Participants
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Exhibit 2
Locations of Federally Recognized American Indian Reservations
Number of States
AIRs, no WIC ITOs
WIC ITOs
No AIRs
(23)
(13)
(15)
NOTE: Stars represent centers of American Indian Reservations which vary in geographic size.
Exhibit 3
Native American Population Of States, 1990
WA
ND
MT
OR
MN
WY
UT
NY
IA
IL
CO
VT
MI
NE
NV
ME
WI
SD
ID
KS
PA
OH
IN
VA
KY
CA
OK
AZ
NM
TN
NC
AR
SC
MS
TX
AL
GA
LA
FL
No Window
Alaska
Hawaii
NJ
MD
WV
MO
NH
MA
CT
Native American
Population
1,000 to 10,000 (14)
10,000 to 25,000 (19)
25,000 to 50,000 (7)
50,000 to 100,000 (7)
100,000 to 253,000 (4)
Exhibit 4
Distribution and Concentration of Native American WIC Enrollment, By Tribal Affiliation of Local
WIC Agencies, 1998
Agency affiliation: State/
Local
ITO state agency
Tribal local agency
Number
Native
Local WIC American
Agencies1 Enrollment
Avg
Percent of Avg # Native
Total Native Americans Mean % Native Distance to
Nearest
American
per Local
American per
2
Enrollment
Agency
Local Agency AIR (miles)
59
49,686
41.0%
842
90.0%
-
State Department of Health
Tribal local agency
Non-tribal local agency
56
1,520
20,986
50,402
17.3%
41.6%
375
33
79.6%
2.7%
23
111
Total Native American
Total WIC
1,635
2,201
121,074
121,074
100.0%
100.0%
74
55
8.5%
6.3%
104
NA
NOTES
Table excludes Puerto Rico, Guam, and the U.S. Virgin Islands.
1 The total number of local WIC agencies is 2,201; 1,635 have at least one Native American WIC enrollee and 21 percent of
local agencies have no Native American WIC enrollees.
2 Average distance to the nearest American Indian Reservation (AIR) is calculated from the center of the local agency service
area to the center of the nearest AIR. Distance to nearest AIR is not calculated for local agencies operated by Oklahoma
tribes.
NA Minimum distance to the nearest American Indian Reservation was not determined for local agencies with no Native American
WIC enrollment.
86
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jurisdiction of 15 State departments of health. 17 The remaining 42 percent of Native American WIC
enrollment was spread across 1,520 agencies with no tribal affiliations.
As shown in Exhibit 4, most WIC agencies affiliated with tribes serve populations that are mostly
Native American (although persons of other racial groups may reside within their service area). ITO
State WIC agencies serve a caseload that is 90 percent Native American; tribal local agencies under
the jurisdiction of State departments of health serve a caseload that is 79.6 percent Native American.
The concentration of Native Americans at these WIC agencies reflects the fact that most tribal
agencies are located on or near reservations, with only four tribal local agencies operated by urban
Indian health centers.
Native Americans receiving WIC services from non-tribal WIC agencies are dispersed across the
country and enrolled at 1,520 local WIC agencies, each serving a small number of Native Americans.
Twenty-one percent of local WIC agencies have no Native American WIC enrollment. Among
agencies with Native American enrollment, on average, only 33 Native Americans are enrolled at
each agency, and they comprise 2.7 percent of the agency's WIC caseload. The average distance of a
non-tribal WIC agency to the nearest reservation is 111 miles.
17
These tribal local agencies are located in the following 15 States: Alaska, Arizona, California, Idaho, Michigan,
Minnesota, Montana, New Mexico, New York, North Dakota, Oregon, South Dakota, Utah, Washington, Wisconsin.
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Characteristics of Native American WIC Participants
9
3.
Demography of Native Americans
Much of the research on the demography and health of Native Americans is based on U.S. census
records, Vital Statistics data, Indian Health Service records, and tribal membership roles. This
section summarizes some of that research, as background for understanding the characteristics of
Native American WIC enrollees examined in the next section. 18
Enumerating the Population
One of the central findings in the study of Native American demography is that Native American selfidentification changed substantially between 1960 and 1990. Changing self-identification has been
documented for American Indians − a subset of Native Americans, excluding Eskimos and Aleuts.
The enumerated population of American Indians was 524,000 in 1960, 793,000 in 1970, 1.37 million
in 1980, and 1.88 million in 1990. Researchers found, however, that population counts from each
decennial census were substantially greater than population estimates based on rates of natural
increase.19 Thornton (1996) reports that the percentages of population "growth" attributable to
changes in self-identification were 25 percent from 1960-70, 60 percent from 1970-80, and 35 percent
from 1980-90. 20 Passel (1996) reports that "with the exception of Oklahoma, most of the population
increase attributable to changing self-identification has occurred in States that have not historically
been major centers of the American Indian population."
Changes in self-identification make it difficult to study trends in the characteristics of Native
Americans over long time periods because the denominator is unstable. In particular, increased selfidentification by persons with marginal amounts of American Indian blood decreases the
homogeneity of persons included in a study of Native Americans.
The United States Census 2000 implemented a revised method of collecting race information,
allowing respondents to select more than one race category to indicate mixed racial heritage. The
revised Census data provide a denominator from which future comparisons can be made, with less
18
In 1995, the National Research Council Committee on Population, with funding from the Public Health Service,
convened a workshop on the demography of American Indian and Alaska Native populations, their major health
problems, and their utilization of healthcare. This section relies heavily on the workshop papers, which were compiled
in Changing Numbers, Changing Needs: American Indian Demography and Public Health.
19
Passel (1996); Passel and Berman (1986), Harris (1994).
20
The census was conducted by enumerators in each year through 1950 and race was assigned by enumerators on the
basis of observation or knowledge. Beginning in 1970, census collection was handled almost entirely through the mail,
and race was self-determined and self-reported by respondents. The 1960 census was a transition year in which forms
were sent through the mail but collected by enumerators; race was assigned by enumerators (Passsel, 1996).
10
Characteristics of Native American WIC Participants
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impact from changes in self-identification, because respondents are not forced to choose only one
race category. Data from Census 2000, however, are not directly comparable with those from prior
censuses due to the changed format of the race question. 21
Census 2000 results show that 2.48 million persons reported American Indian and Alaskan Native as
their only race; an additional 1.64 million persons reported American Indian and Alaskan Native in
combination with one or more other race categories. While these data are not directly comparable to
the 1990 census, the lower bound count of Native Americans in year 2000 (2.48 million) is consistent
with population estimates based on rates of natural increase.22 This lower bound count of the Native
American population in year 2000 is 26 percent greater than the 1990 census count.
While Census enumeration is based on self-reported racial and ethnic identification, an alternative
count of Native Americans comes from tribal membership roles and is determined by ancestral
lineage and degree of Indian blood. 23 Tribal membership as a percentage of the enumerated Native
American population decreased over time as self-identification of Native Americans increased and
intermarriage diluted Indian blood. Thornton (1996) estimates that two-thirds of American Indians in
the 1980 Census, and about 60 percent of American Indians in the 1990 census, were enrolled
members of Tribes. Only certified members of Indian tribes receive benefits from Tribal
governments.
Geographic Distribution of Native Americans
According to the 1990 Census, the nation's 1.9 million Native Americans lived in all 50 States and the
District of Columbia , but compared to the total US population, Native Americans were more highly
concentrated in the West and in non-metropolitan areas. In 1990, the percentage of persons residing
in Western States was 45.6 percent for Native Americans, and 21.2 percent for the total US
population; the percentage residing in metropolitan areas was 30.8 for Native Americans and 79.7 for
the total US population.24 In 1996, over half (54 percent) of all Native American infants were born to
21
US Bureau of Census reports that data are not comparable "due, in large part, to giving respondents the option to report
more than one race. Other factors, such as reversing the order of the questions on race and Hispanic origin and
changing question wording and format, also may affect comparability" (http://www.census.gov/PressRelease/www/2001/raceqandas.html).
22
The Census Bureau estimate of Native Americans in year 2000 was 2.45 million, based on the 1990 census adjusted for
births, deaths, and migration. (Source: Population Estimates of the United States by Sex, Race, and Hispanic Origin.)
23
See Thornton (1987) for the membership requirements of individual tribes and changes in membership requirements
over time.
24
Sources of statistics are Census (1994) and Census (1999).
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11
mothers residing in only six States −Arizona, Oklahoma, California, New Mexico, Alaska, and
Washington. In contrast, only 20 percent of all U.S. births occurred in these States (NCHS, 1998).
Snipp (1996) notes that "the distribution of the American Indian population clearly bears the marks of
historical events and especially the influence of federal policies." Two main federal policies
influenced the location of Native Americans. During the nineteenth century, government removal
policies pushed Native Americans from the east to the west onto reservations originally designed to
quarantine them (Indian Removal Act of 1830). After World War II, Native American migration into
urban areas began as a result of relocation programs aimed at enhancing Native Americans' economic
opportunities and assimilation (Indian Relocation Act of 1956). Census data seem to support Snipp's
hypothesis about the lasting influence of these policies. Today, the majority of American Indians
reside in the West, and Native Americans residing in metropolitan areas are highly concentrated in
areas targeted by the federal relocation programs of the mid-20th century. 25
As previously discussed, in 1990, 24 percent of Native Americans lived on reservation lands; an
additional 10 percent lived in Oklahoma within tribal jurisdictions.26 The number residing on tribal
lands, however, does not fully reflect the number of Native Americans within close proximity to
reservations who may participate in tribal life and receive services from tribal governments. In 1990,
the Indian Health Service (IHS) reported that 58.5 percent of all Native Americans lived within IHS
service areas, which are defined as areas on or near reservations.
Economic Conditions
It is no surprise that a large percentage of Native American women, infants, and children participate
in the WIC program. WIC is designed to benefit low-income persons who are at nutritional risk, with
an income-eligibility cutoff of 185 percent of the federal poverty level. According to the 1990
census, 27 percent of Native American families had incomes below the poverty level, and 66 percent
of all Native American pregnant and postpartum women, infants, and children were estimated to be
income-eligible for WIC (USDA, 1993).27
25
The cities designated as urban relocation centers or affected by urban relocation were Chicago, Cleveland, Dallas,
Denver, Los Angeles, Oakland, Oklahoma City, San Francisco, San Jose, Seattle and Tulsa (Shumway et al., 1995).
26
Reservation lands include American Indian Reservations, Alaskan Native Villages, and State recognized reservations.
(Snipp, 1996).
27
The following percents of Native Americans were estimated to be income-eligible for WIC in 1990: 59% of pregnant
women, 67% of breastfeeding women, 53% of postpartum women, 66% of infants, and 69% of children (USDA, 1993).
12
Characteristics of Native American WIC Participants
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Sandefur and Liebler (1996) sum up the economic status of American Indians as follows:
"The U.S. Indian population is younger, poorer, more likely to be unemployed and
has larger families on average than the U.S. population in general. This is especially
true of the reservation population, whose median age is over 10 years younger than
that of the general U.S. population, whose poverty and unemployment rates are close
to four times higher, and whose average family size is one full person larger."
Perhaps the most disturbing trend for the Native American population is that poverty is not steadily
decreasing over time. Exhibit 5, taken from Trosper (1996), shows that poverty among American
Indians fell substantially from 1969 to 1979. But during the subsequent decade (1979 to 1989)
poverty among American Indians increased, while whites and blacks experienced no change in
poverty levels.
Exhibit 5
Prevalence of Poverty in Decennial Census Years, By Race
Population
1969
Total U.S.
Whites
Blacks
American Indians
Sources:
10.7
8.6
29.8
33.3
Percent of Families in Poverty
1979
9.6
7.0
26.5
23.7
1989
10.0
7.0
26.3
27.0
U.S. Bureau of the Census, General Social and Economic Statistics, 1972, 1983, 1993.
Table taken from Trosper (1996).
The trend in poverty on reservations was similar to the trend among all Native Americans − though at
a much higher level. The percentage of families on reservations with income below the poverty
threshold was 57 percent in 1969, 43 percent in 1979, and 51 percent in 1989 (Trosper, 1996). 28
Trosper (1996) provides a discussion of the factors contributing to increased poverty on reservations
during the 1980s. These factors include migration off reservations, changes in self-identification, and
28
Based on census data for 23 reservations for which comparable data were collected in each of the 1970, 1980, and 1990
censuses. The 1970 census collected data for a selection of reservations; subsequent censuses collect data for all
reservations.
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Characteristics of Native American WIC Participants
13
decreased federal expenditures (especially for Indian housing and economic development). Federal
expenditures for Indian programs peaked in 1979 and then declined 44 percent by 1989. 29
While poverty for Native Americans is greater on reservations than off reservations, Trosper (1996)
also documents considerable variation in individual economic well-being across reservations. The
factors accounting for variation in poverty across reservations include: differences in the amount and
quality of land per person, variations in population change, variations in cultural values concerning
the accumulation of wealth, and different rates of economic development following the adoption of
tribal self-determination into Public Law in 1975. Gaming does not explain variation in income
among reservations because it was not a significant source of income for Indian tribes until the 1990s,
although a few reservations had significant bingo revenue prior to 1990.
Public Health Concerns
The WIC program is designed to combat a very specific set of public health concerns: the nutritional
health of women during pregnancy and childbirth, and the nutritional health of infants and children up
to age 5. WIC is designed to be an adjunct to good health care during these critical periods of growth
and development, which are subject to influence by good overall nutrition.
Native American women and children face particularly difficult health issues, many related to
nutrition. Compared with the overall population of U.S. women, Native American women are
younger when they give birth, begin prenatal care at a later point in pregnancy, have higher rates of
substance use (smoking and alcohol) during pregnancy, and are more likely to have diabetes during
pregnancy. Their infants are less likely to have low birthweight (although more likely to die if they
have low birthweight), more likely to have high birthweight, and more likely to die during the first
year of life.30
The health and health care utilization trends of American Indians are documented in annual
publications of the Indian Health Service (IHS). The patterns noted above are shown in Exhibit 6.
One of the noteworthy features of statistics from the Indian Health Service, however, is that they do
not represent the entire population of Native Americans in the United States. The Indian Health
Service provides health care services within service areas defined to be on or near reservations. IHS
29
In 1990 dollars, total federal expenditures for Indian programs declined from $4.45 billion in 1979 to $2.5 billion in
1989 (Trosper, 1996).
30
These patterns are documented in IHS (1997a) and IHS (1997b). The higher rate of infant mortality among American
Indian low-birthweight infants, compared with low-birthright infants of other races, is documented in Ventura (1998).
14
Characteristics of Native American WIC Participants
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Exhibit 6
Selected Characteristics of Native American Pregnancies and Births, 1994-96
IHS Service
Population
Percent of births with characteristic
Mother's age at birth of first child less
than 20 years 1
All Races
45.2 %
24.2 %
Mother received prenatal care
in 1st trimester
66.5
81.3
Mother smoked during pregnancy
20.4
13.9
Mother drank alcohol during pregnancy
4.5
1.5
Mother had diabetes during pregnancy
4.5
2.5
Low birthweight infant
(under 2,500 grams)
6.0
7.3
High birthweight infant
(4,000 grams or more)
12.7
10.3
9.3
7.6
Neonatal mortality rate 2
(Under 28 days)
4.5
4.9
Postneonatal mortality rate 2
(28 days to 1 year)
4.8
2.7
Mortality rates per 1,000 live births
Infant mortality rate 2
(Under 1 year)
1
Age at first birth is based on 1992-94 births; all other statistics are based on 1994-96 births.
IHS adjusts mortality rates to compensate for miscoding of Indian race on death certificates.
Sources: IHS, Regional Differences in Indian Health, 1998-99 and Indian HealthFocus: Women,
1997. NCHS, Report of Final Natality Statistics, 1997.
2
tracks the wellbeing of Indians only within IHS service areas, which contain approximately 60
percent of all self-identified Native Americans.31 Examination of Vital Statistics data for all
Native Americans, however, shows almost no difference between all Native Americans and those in
IHS service areas.32
31
IHS statistics of vital events (births and deaths) are calculated from data from the National Center for Health Statistics
(NCHS), using the subset of American Indians residing in IHS service areas as defined by county of residence (IHS,
1997a).
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Characteristics of Native American WIC Participants
15
4.
Characteristics of Native American WIC Participants, On and
Off Reservations
As stated earlier, the WIC program provides benefits to a large percentage of Native American
women, infants, and children. The program is designed to combat nutritional deficiencies, improve
birth outcomes, and assure proper early child hood growth through provision of supplemental foods,
nutrition education, and referrals to health and social services. These goals are directly aimed at some
of the health problems prevalent among Native Americans − delayed prenatal care, prenatal incidence
of diabetes and substance use, and infant mortality.
This section examines the characteristics of Native Americans who enroll in the WIC Program, trends
in WIC enrollment of Native Americans over time, and differences in characteristics of Native
American WIC enrollees according to location on and off reservations.
WIC Caseload Trends
The WIC program grew enormously in the 1990s, with enrollment increasing from 5.75 million in
1992 to 8 million in 1998. Most of this growth occurred from 1992 to 1996 and has been attributed to
three factors: funding increases which extended service to more lower-priority individuals, increases
in the number of individuals income-eligible for the program, and an increase in the number of
eligible persons who applied (USDA, 2000). 33
In contrast to the overall caseload trends, WIC enrollment by Native Americans has undergone only
modest growth during the 1990s. Exhibit 7 shows the growth in WIC enrollment from 1992 to 1998
by participant category, for Native Americans and all races (bottom panel). WIC enrollment by
Native Americans grew by 17 percent from 1992 to 1998, in contrast to 40 percent growth in WIC
overall. Growth in Native American enrollment varied by certification category, with the greatest
increase among postpartum women (44.9 percent) and very little increase among pregnant women
(4.2 percent). In contrast, during the same period, the overall US caseload of breastfeeding and
postpartum women nearly doubled, and the total number of children enrolled in WIC increased by
slightly more than 50 percent.
The modest growth in Native American WIC enrollment during the 1990s was accompanied by a
shift in the distribution of enrollment at tribal and non-tribal agencies. Exhibit 8 shows that
33
16
The WIC Program is not an entitlement program. Funding increases during the 1990s enabled WIC agencies to
steadily increase the number of eligible persons served by the program. The program is currently close to full funding.
Characteristics of Native American WIC Participants
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Exhibit 7
Native American WIC Enrollment, 1992 - 1998
1992
1994
1996
1998
Percent
Change
1992-98
Pregnant
Breastfeeding
Postpartum
Total Women
11,997
5,101
4,790
21,889
12,045
5,501
5,655
23,201
12,449
5,773
6,618
24,839
12,506
5,996
6,940
25,442
4.2%
17.5%
44.9%
16.2%
Infants
Children
23,824
57,532
27,071
66,645
27,431
70,579
27,656
68,041
16.1%
18.3%
103,245
116,916
122,849
121,140
17.3%
5,754,003
6,907,848
7,747,441
8,042,758
39.8%
Total Native American
WIC Enrollment
Total WIC
Percent Change in WIC Enrollment, 1992 to 1998: Native Americans and All WIC
96.7%
100%
87.6%
90%
Native Americans
80%
Percent Change
All WIC
70%
60%
50.8%
50%
44.9%
40%
30%
20%
10%
14.3%
18.3%
16.1%
17.5%
18.3%
4.2%
0%
Pregnant
Breastfeeding
Postpartum
Infants
Children
Certification Category
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17
Exhibit 8
Distribution of Native American WIC Enrollment by Tribal Affiliation of Certifying Agency
70,000
1992
1998
60,000
50,402
49,686
49,537
50,000
36,136
40,000
30,000
20,986
17,572
20,000
10,000
ITOs
Tribal locals
Non-tribal local
total enrollment through Indian State WIC agencies (ITOs) was virtually unchanged over the period
(0.3 percent growth). Enrollment of Native Americans at Tribal local agencies increased by 19
percent and enrollment at non-tribal WIC agencies increased by 40 percent (matching the growth in
the overall WIC caseload).
The shift in the distribution of enrollment at tribal and non-tribal agencies cannot be attributed to the
number of Tribal agencies administering WIC programs. From 1992 to 1998 the number of ITOs
operating State WIC agencies increased from 31 to 33; the number of tribal local agencies under the
jurisdiction of State departments of heath increased from 54 to 56. 34 The differential growth in WIC
enrollment at tribal versus non-tribal agencies may be due to population movement off reservations,
or to increased self-identification of Native Americans off reservations. However, these hypotheses
cannot be examined until the detailed Census 2000 data are released.35
Geographic Distribution of Native American WIC Participants
The regional and metro/non-metro distribution of Native American WIC enrollment corresponds to
the overall distribution of the Native American population. Census data (1990) show that 46 percent
of Native Americans live in the West and 59 percent live in non-metropolitan areas; 1998 WIC data
34
The increase from 54 to 56 tribal local agencies includes a loss of 9 agencies in existence in 1992 and an addition of 11
new agencies by 1998.
35
Some non-tribal local agencies are located near reservations as discussed in the next section.
18
Characteristics of Native American WIC Participants
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show that 44 percent of Native American WIC enrollees live in the West and 62 percent live in nonmetropolitan areas. WIC enrollees, however, appear to be more concentrated on or near tribal lands.
The 1990 Census data showed that 37 percent of Native Americans reside on tribal lands and, in
1998, IHS estimated that 60 percent of Native Americans lived in IHS service areas (which include
areas on or near tribal lands). The 1998 WIC data, which can not be mapped to IHS service areas,
show that 63 percent of Native American WIC enrollees live on or near reservations and 75 percent
live on or near tribal lands.
For this paper, residence of WIC enrollees on or near a reservation was determined by the proximity
of each local WIC agency's service area to the nearest American Indian Reservation (AIR).36 Local
agency service areas were defined by county boundaries (or by the boundaries of a group of counties)
according to documentation provided by each State agency.37 Distance was measured from the center
of each of the 2,200 local WIC agencies' service areas to the center of each AIR. All persons enrolled
through a local WIC agency within 20 miles of a reservation, or whose service area contained part of
a reservation, were determined to reside "on or near a reservation." This definition of "on or near a
reservation" is not directly comparable to Indian Health Service areas. In particular, IHS includes all
of Oklahoma in its service area while we have categorized much of Oklahoma as off-reservation.
Exhibit 9 shows the distribution of Native American WIC enrollment by proximity to reservations.
Overall, 75 percent of Native American WIC enrollees live in areas served by tribal governments, or
within relative proximity to tribal lands, and 63 percent live on or near reservations. Of the Native
American WIC participants located on or near reservations, most are enrolled in WIC through tribal
agencies. Persons are shown as residing in Oklahoma Tribal Jurisdiction Statistical Areas (TJSAs) if
they enrolled in WIC through Oklahoma tribes that do not have reservations. 38 TJSAs are boundaries
defined by the US Bureau of Census and identify the geographic areas in which Oklahoma tribes
provide benefits and services to tribal members
Native American WIC enrollees are more highly concentrated on reservation lands than the overall
Native American population. This is not surprising because the WIC program provides benefits to
low-income individuals and poverty among Native Americans is concentrated on reservations. We
should note, however, that our measure of proximity is likely to overstate the number of WIC
36
The place of residence of individual WIC enrollees is not captured in the PC data.
37
A small number of local agencies are municipal agencies but we defined all boundaries at the county level.
TJSAs were used to tabulate population data for the 1990 census; the boundaries correspond to the approximate
boundaries of Oklahoma reservations as they existed prior to Oklahoma statehood. The mapping of Oklahoma tribal
jurisdictions was revised for the year 2000 census, replacing 17 TJSAs with 29 Oklahoma Tribal Statistical Areas.
38
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Characteristics of Native American WIC Participants
19
Exhibit 9
Distribution of Native American WIC Enrollment by Proximity to Reservations
Tribal agency-On or near
reservation
25%
46%
Non tribal agency- On or near
reservation
Oklahoma TJSAs
12%
Off reservation
17%
enrollees residing near tribal lands because it is not based on the residence of indiv idual WIC
enrollees relative to tribal lands, but on the proximity of WIC agency service areas to tribal lands.
(WIC agency service areas are typically one or more counties.)
The regional distribution of Native American WIC enrollees is shown in Exhibit 10. WIC enrollees
are highly concentrated in three regions where American Indian Reservations are located: the
Southwest, Mountain Plains, and Western regions contain 82 percent of all Native American WIC
enrollees. The exhibit shows the regional distribution of WIC enrollees overall and according to
residence on or near reservations. WIC enrollees living on or near reservations are located primarily
in the Western and Mountain Plains regions; WIC enrollees living off reservations are somewhat
more distributed across regions, but the largest concentrations are in the Southwest and in Oklahoma,
where tribes do not have formal reservations. The bottom panel of the exhibit shows the distribution
between reservation and non-reservation within regions.
Demographics of Native American WIC Participants
US Census data (1990) show differences between the Native American population and other racial
and ethnic groups, and difference within the overall Native American population by proximity to
reservations. (The reservation population is younger, poorer, and has larger families than the nonreservation population.) These Census findings cannot necessarily be generalized to the WIC
population, however, because WIC serves a group that is economically homogenous: all WIC
enrollees have income below 185 percent of the poverty level.
20
Characteristics of Native American WIC Participants
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Exhibit 10
Regional and Metropolitan Distribution of Native American WIC Enrollment, By
Location on Reservation Lands 1998
Native American WIC Enrollment
On or Near
Reservations
Off
Reservations
Total
Total WIC
FNS Region
Northeast
Mid-Atlantic
Southeast
Midwest
Mountain Plains
Southwest
Western
Total
1.5%
0.3
2.2
9.0
17.9
7.9
61.1
100.0
5.1%
3.6
12.8
4.8
15.8
43.5
14.6
100.0
2.8%
1.6
6.2
7.4
17.1
21.3
43.6
100.0
10.0%
12.2
19.0
14.2
14.3
6.4
23.8
100.0
Metro/Non-metro Area
Non-metropolitan
Metropolitan
Total
66.6
33.4
100.0
54.3
45.7
100.0
62.0
38.0
100.0
19.4
80.6
100.0
Total
75,395
45,679
121,074
8,042,758
NOTE: Enrollment of Indian state agencies operated by federally recognized Oklahoma tribes which do not have a
reservation are counted as "on or near reservations" because tribal governments exercise self-government within
Oklahoma "Indian country."
Percent of Native American WIC Enrollment On or Near a Reservation, By FNS
Region, 1998
100%
80%
60%
40%
20%
0%
Northeast
Mid-Atlantic
On or near a reservation
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Southeast
Midwest
Mountain
Plains
Southwest
Western
Off reservation
21
Exhibit 11 shows the age distribution of Native American WIC enrollees (by location on or near a
reservation and overall), and the age distribution of all WIC enrollees. For the most part, the age
distribution of all Native American WIC enrollees is not very different from that of the overall WIC
population, although this comparison is somewhat hampered by a greater incidence of missing age for
Native Americans. Compared to all WIC enrollees, Native American WIC women are somewhat
more likely to be under age 20 (24.4 versus 22.8 percent); Native American infants are slightly less
likely to enroll in WIC at 1-3 months of age (86.7 versus 88.4 percent); and Native American WIC
children are less concentrated in the 1-3 year-old age groups (53.9 versus 60.7 percent).
The comparison of Native American WIC enrollees by location on versus off reservations shows that
Native American WIC women off reservations are more likely to be under age 20 (26.2 versus 23.2
percent); Native American infants off reservations are slightly less likely to enroll in WIC at 0-3
months of age (85.9 versus 87.2 percent); and Native American WIC children off reservations are
more concentrated in the 1- and 2-year-old age groups (57.8 versus 51.8 percent). Compared to Native
Americans off reservations, the age distribution of Native American women and infants on
reservations more closely resembles that of all WIC women and infants; in contrast the age
distribution of Native American children off reservations more closely resembles that of all WIC
children.
Exhibit 12 shows the distributions of Native American WIC enrollees and all WIC enrollees by
certification category, family size, public assistance receipt, and poverty status. For these measures,
there are some large differences between Native American WIC enrollees and all WIC enrollees, as
well as between Native Americans on and off reservations.
Compared to total WIC enrollment, Native American WIC enrollment is more concentrated in the
children category (56.2 versus 51.2 percent) reflecting the fact that Native American families have
more children. Mean family size is 4.2 persons for Native American WIC enrollees and 3.9 persons
for all WIC enrollees; a greater percentage of Native Americans are in families of more than 4
persons (37.7 versus 29.6 percent).
Native American WIC enrollees have higher rates of public assistance receipt than all WIC
enrollees. Native Americans are more likely to receive TANF (21.1 versus 17.0 percent) and more
likely to receive food assistance from the Food Stamp Program (FSP) or the Food Distribution
Program on Indian Reservations (FDPIR) (41.6 versus 26.6 percent). Native Americans are slightly
less likely to have Medicaid (47.1 versus 48.3 percent) but this probably understates Medicaid
22
Characteristics of Native American WIC Participants
Abt Associates Inc.
Exhibit 11
Distribution of Age at Certification of Native American WIC Enrollees, 1998
Native American
On or Near
Reservations
Off
Reservations
Total
Pregnant women
Under 15 years
15 - 17 years
18 - 19 years
20 - 34 years
35 or more years
Age not reported
1.4
10.6
13.9
67.0
7.0
0.5
1.3
10.9
16.3
66.2
5.3
0.7
1.4
10.7
14.8
66.7
6.3
0.5
0.8
10.1
15.3
67.9
5.8
0.2
Breastfeeding women
Under 15 years
15 - 17 years
18 - 19 years
20 - 34 years
35 or more years
Age not reported
1.2
6.3
10.5
71.1
10.8
0.9
2.3
4.3
9.6
74.2
9.7
2.0
1.6
5.7
10.3
72.1
10.5
1.3
0.2
4.1
8.5
76.0
10.7
0.5
Postpartum women
Under 15 years
15 - 17 years
18 - 19 years
20 - 34 years
35 or more years
Age not reported
1.8
8.9
12.6
68.7
8.0
1.0
2.3
11.0
15.1
65.9
5.6
1.9
2.0
9.8
13.7
67.5
6.9
1.4
0.5
8.9
14.6
69.4
6.0
0.6
Total women
Under 15 years
15 - 17 years
18 - 19 years
20 - 34 years
35 or more years
Age not reported
1.5
9.0
12.7
68.5
8.3
0.7
1.8
9.7
14.7
67.6
6.2
1.3
1.6
9.3
13.5
68.2
7.5
0.9
0.6
8.5
13.7
70.0
6.9
0.4
Infants
0 - 3 months
4 - 5 months
6 - 8 months
9 - 11 months
Age not reported
87.2
3.8
6.8
1.6
0.5
85.9
3.1
5.4
2.4
3.2
86.7
3.5
6.2
1.9
1.6
88.4
2.7
6.3
2.4
0.2
Children
1year
2 years
3 years
4 years
Age not reported
29.0
22.8
21.2
16.8
10.1
33.5
24.3
20.8
14.7
6.7
30.6
23.3
21.1
16.1
8.9
35.6
25.1
22.3
16.2
0.8
75,394
45,680
121,074
8,042,758
Total
Abt Associates Inc.
Total WIC
23
Exhibit 12
Demographic Characteristics of Native American WIC Enrollees, 1998
Native American
On or Near
Reservations
Off
Reservations
10.0
5.5
5.2
21.5
57.8
10.9
4.1
6.6
25.0
53.4
10.3
4.9
5.7
22.8
56.2
11.1
4.8
7.3
25.5
51.2
2.1
11.1
21.1
23.7
18.1
23.8
100.0
2.6
12.4
26.4
27.8
16.8
14.0
100.0
2.3
11.6
23.1
25.2
17.6
20.1
100.0
2.1
14.2
27.1
27.1
16.2
13.4
100.0
0.6
0.7
0.6
0.9
4.4
4.0
4.2
3.9
24.6
39.4
6.2
47.3
15.2
29.5
5.5
46.9
21.1
35.7
5.9
47.1
17.0
26.5
0.1
48.3
0.1
0.2
0.2
0.7
12,442
11,110
12,144
11,280
12,322
11,180
12,479
11,440
41.4
34.1
12.4
5.8
5.7
0.3
0.2
0.1
0.1
100.0
34.9
36.7
14.4
6.4
6.7
0.4
0.2
0.1
0.2
100.0
38.9
35.1
13.2
6.0
6.1
0.3
0.2
0.1
0.2
100.0
36.1
33.6
14.6
7.1
7.7
0.4
0.2
0.1
0.1
100.0
Poverty not reported
16.6
11.4
14.7
14.6
Total WIC enrollment
75,394
45,680
121,074
Certification category
Pregnant
Breastfeeding
Postpartum
Infants
Children
Family size1
1 person
2 persons
3 persons
4 persons
5 persons
6 or more persons
Total
Size not reported
Mean family size
Public Assistance
TANF
Food Stamps
FDPIR2
Medicaid
Percent migrant
Mean annual income
Median annual income
Poverty Status1
1-50%
51-100%
101-130%
131-150%
151-185%
186-200%
201-225%
226-250%
Over 250%
Total
Total
Total WIC
8,042,758
NOTES:
Percent distributions are calculated over records with non-missing data.
1
2
Native Americans not living on Indian reservations may receive FDPIR if they live in an approved near-reservation
area and the household meets the eligibility standards.
24
Abt Associates Inc.
eligibility among Native Americans because certified members of Native American tribes receive
health care from the Indian Health Service and may not apply for Medicaid.
Mean and median family income is not substantially different for Native Americans, compared to all
WIC enrollees, but on average, Native American family income is a lower percentage of the federal
poverty guidelines because Native Americ an families are larger. Compared to all WIC enrollees,
more Native Americans have income below 100% of the poverty level (74.0 versus 69.7 percent).
There are large differences between Native American WIC enrollees on and off reservations with
respect to family size, public assistance receipt, and income. Among Native Americans on or near
reservations, 23.8 percent have family size of 6 or more persons; this is ten percentage points greater
than the groups of Native Americans off reservations and all WIC enrollees. Greater poverty on
reservations is evident from higher rates of participation in TANF and food assistance. 39 The
difference in TANF receipt between Native Americans on and off reservations is 9.4 percentage
points and the difference in food assistance is 10.6 percentage points. Rates of Medicaid receipt are
comparable for Native Americans on and off reservations and all WIC.
Mean and median family income is not substantially different for Native Americans on and off
reservations, but due to larger family sizes on reservations, poverty is somewhat greater on
reservations. The percentage of Native Americans with income below 100% of the poverty level is
75.5 on reservations and 71.6 off reservations.40
39
Tribal organizations may choose to participate in either the Food Stamp Program or the Food Distribution Program on
Indian Reservations.
40
Differences in poverty status should be viewed with caution because poverty level is not reported for 16.6 percent of
Native American WIC enrollees on reservations and 11.4 percent of Native American WIC enrollees off reservations.
Abt Associates Inc.
Characteristics of Native American WIC Participants
25
5.
Prevalence of Nutrition Risks in Native American WIC
Participants
In addition to income eligibility, all WIC applicants must be at nutritional risk to qualify for WIC
benefits. WIC identifies nutritional risk in five major categories: anthropometric, biochemical,
clinical/medical, dietary, and predisposing. This section examines the prevalence of nutrition risks
among Native Americans and compares the risks reported for Native Americans on or near
reservations with risks reported for Native Americans off reservations.
The WIC program screens for nutrition risks during the application process and the presence of
nutritional risk is recorded in certification files. Anthropometric risks are determined from height and
weight measurements; biochemical risks are determined from blood tests for iron deficiency; dietary
risks are determined from information collected through twenty-four hour recalls or food frequency
checklists; and clinical and medical risks are determined from information obtained from authorized
medical personnel. State WIC agencies, when submitting data to the biennial PC studies, include
information on up to three nutritional risks for each WIC enrollee.
Reporting of Nutrition Risks
One potential difficulty in examining the prevalence of nutritional risks is that all risks may not be
recorded during the certification process because one risk is sufficient for certification. State agencies
generally set guidelines for the number of risks to be recorded. Exhibit 13 summarizes State agency
policies. As shown in the exhibit, in 1998, 92 percent of all WIC enrollment was in States requiring
that nutrition information be recorded for every identified nutrition risk, or a set number of risks that
equaled or exceeded three. Six percent of WIC enrollment was in States allowing local certifiers to
determine the number of criteria to record; less than one percent of enrollment was in States allowing
that the most easily and quickly identified risk(s) be recorded.41
Compared with total WIC enrollment, Native Americans were more likely to be enrolled at State
WIC agencies that give local certifiers discretion in determining the number of nutrition risks to
record on certification records. Exhibit 13 shows that local discretion leads to fewer reported risks on
average, so the prevalence of risks among Native Americans may be understated relative to the
prevalence of risks among all WIC enrollees. Similarly, a higher percentage of Native American
WIC enrollees on or near reservations are enrolled through agencies with local discretion, so
41
26
Based on author's tabulations of data from the PC98 Survey of State WIC Agencies.
Characteristics of Native American WIC Participants
Abt Associates Inc.
Exhibit 13
State Agency Policies for Recording Nutrition Risk at Certification
Number
State
Agencies
State Policy
Percent of
WIC
Enrollees
Avg
Number
Risks in
PC data1
Percent American Indian WIC
Total
On or near
reservations
Off
reservations
All risk criteria are recorded
A set number of the more
important criteria are recorded2
The most easily and quickly
identifiable criteria are recorded
Local certifiers decide which
criteria and how many criteria to
record
Other
56
21
62.4
29.2
1.93
1.69
63.6
16.0
60.2
12.8
69.2
21.3
3
0.4
1.90
1.9
0.1
4.9
7
5.9
1.58
14.0
20.6
3.2
1
2.1
1.8
4.5
6.3
1.4
Total
88
100.0
1.83
1
The average number of risks recorded in the PC data understates the total number of risks recorded in State systems that
provide for more than three risks.
2
All States with this policy specify three or more risks be recorded.
Source: PC98 Summary of State Programs.
prevalence of risks among Native Americans on or near reservations may be understated relative to
prevalence of risks among Native Americans off reservations.
Despite the limitations imposed by variation in State policies regarding the documentation of risks,
PC98 data show that, in all participant categories, Native Americans on reservations have more
reported risks than Native Americans off reservations. (Native Americans on reservations account
for 63 percent of total Native American WIC enrollment.) Exhibit 14 shows the percent of enrollees
with more than one reported risk, with percentages measured over those with non-missing risk data.
Both on and off reservations, the majority of Native American WIC participants enroll in the program
with multiple nutritional risks present at certification. With the exception of breastfeeding and
postpartum women, Native Americans on and off reservations are more likely to have multiple risks
than all WIC enrollees  even though the policies of State agencies in States where Native
Americans reside may result in relatively more underreporting of risks for Native Americans.
Abt Associates Inc.
Characteristics of Native American WIC Participants
27
Exhibit 14
Percent of WIC Enrollees with More than One Nutritional Risk Present at Certification
100
On or near reservations
90
Off reservations
80
All WIC
Percent
70
60
50
40
30
20
10
0
Pregnant
Breastfeeding
Postpartum
Infants
Children
Prevalence of Risks
Exhibits 15 and 16 show the prevalence of nutrition risks for Native American WIC women (by
location on or off reservations and overall) and for all WIC women. Exhibit 15 shows that among all
women, and for all risk categories except biological risks, Native American women have greater risk
prevalence than all WIC women. The comparison of Native American women on and off
reservations, however, shows no clear pattern: Native American women living on or near
reservations have a higher prevalence of anthropometric risks and some clinical risks, while Native
American women living off reservations have a higher prevalence of biological risks and some
clinical risks.
The specific risks that are more prevalent for Native American WIC women on reservations,
compared to women off reservations, are: high weight-for-height (44.5 versus 36.7 percent),
nutrition-related risks (23.5 versus 7.9 percent), and breastfeeding mother/infant dyad (16.6 versus 7.8
percent). The greater prevalence of breastfeeding mother/infant dyad risk may reflect different WIC
agency policies with respect to use of this risk category; all breastfeeding mothers may be certified
for WIC on the basis of this risk alone but the risk may not be recorded when other risks are present.
Exhibit 16 (which repeats the information in Exhibit 15, broken out by WIC participant category)
clearly shows that a greater percentage of breastfeeding women on reservations are assigned the
breastfeeding risk (60.4 versus 38.8 percent).
28
Characteristics of Native American WIC Participants
Abt Associates Inc.
Exhibit 15
Prevalence of Reported Nutrition Risks among Native American WIC Women and All
WIC Women, 1998
Total Native American Women
On or Near
Off
Reservations Reservations
Total
Total Wic
Anthropometric
Low weight-for-height
High weight-for-height
Short stature
Inappropriate growth
Other anthropometric risk
62.1
2.9
44.5
0.4
20.4
0.7
56.4
7.1
36.7
0.4
20.7
0.8
59.8
4.6
41.4
0.4
20.6
0.8
55.1
6.1
32.3
0.9
24.6
1.7
Biological
Hematocrit/hemoglobin < state std
Other biochemical risk
16.6
16.6
0.0
25.9
25.8
0.2
20.3
20.3
0.1
27.3
27.2
0.1
Clinical Risk
Pregnancy induced conditions
Delivery of low birthweight or
premature infant
Prior stillbirth, miscarriage, etc
General obstetrical risks
Nutrition-related risks
Substance abuse
Other health risk
72.4
4.0
68.7
6.9
70.9
5.2
58.3
3.2
1.8
2.3
42.5
23.5
13.4
4.9
1.6
7.1
48.0
7.9
14.9
2.7
1.7
4.2
44.7
17.3
14.0
4.0
2.2
4.2
39.2
7.8
10.9
5.5
Dietary Risk
Inadequate/inappropriate nutrient
intake
Other dietary risk
48.3
50.4
49.1
46.6
47.2
1.5
48.0
2.5
47.5
1.9
45.2
2.2
Other risks
Regression
Transfer (risk is unknown)
Breastfeeding mother/infant dyad
Infant of a WIC-eligible mother
Homelessness/migrancy
Other nutritional risks
19.1
0.2
0.3
16.6
0.1
2.3
9.3
0.2
0.9
7.8
0.1
0.6
15.2
0.2
0.5
13.0
0.1
1.7
11.3
0.1
1.6
8.4
0.1
1.3
Number of reported risks
One
Two
Three
None reported
9.1
33.9
56.4
0.7
11.3
35.0
53.3
0.4
10.0
34.3
55.1
0.6
20.3
33.0
46.2
0.5
Number WIC participants
9,637
6,452
16,091
1,873,116
NOTES
For PC98, WIC agencies could report up to three nutritional risks for each participant. This table includes all risks
reported for every participant so that column and row percentages sum to more than 100 percent.
Abt Associates Inc.
29
Exhibit 16
Prevalence of Reported Nutrition Risks among Native American WIC Women, By Certification
Category, 1998
Pregnant women
Breastfeeding women
Postpartum women
On or Near
Off
Reservations Reservations
On or Near
Off
Reservations Reservations
On or Near
Off
Reservations Reservations
Anthropometric
Low weight-for-height
High weight-for-height
Short stature
Inappropriate growth
Other anthropometric risk
64.3
3.8
38.4
0.7
33.0
0.7
60.5
9.0
33.8
0.8
31.1
0.6
60.1
2.2
50.7
0.2
8.5
0.2
52.8
4.9
39.8
0.1
11.5
0.5
60.0
1.7
49.2
0.0
9.5
1.3
51.7
5.3
39.7
0.0
8.9
1.3
Biological
Hematocrit/hemoglobin < state std
Other biochemical risk
11.8
11.8
0.0
23.6
23.4
0.2
15.1
15.1
0.1
21.5
21.4
0.1
27.4
27.4
0.0
32.6
32.6
0.2
Clinical Risk
Pregnancy induced conditions
Delivery of low birthweight or
premature infant
Prior stillbirth, miscarriage, etc
General obstetrical risks
Nutrition-related risks
Substance abuse
Other health risk
27.0
4.6
10.8
8.8
32.0
3.0
10.7
4.8
26.9
3.9
10.3
5.2
1.8
3.5
47.5
20.9
15.3
6.2
1.2
8.3
51.3
9.1
15.3
1.7
1.0
0.2
35.3
29.0
8.9
3.1
1.3
4.0
39.2
5.9
11.9
4.9
2.6
2.1
41.0
22.6
14.5
4.3
2.4
7.2
48.1
7.3
16.2
3.1
Dietary Risk
Inadequate/inappropriate nutrient
intake
Other dietary risk
49.5
50.5
39.7
53.1
55.2
48.3
49.3
48.4
39.6
51.5
51.4
45.1
0.6
2.2
0.6
1.8
4.2
3.3
Other risks
Regression
Transfer (risk is unknown)
Breastfeeding mother/infant dyad
Infant of a WIC-eligible mother
Homelessness/migrancy
Other nutritional risks
3.9
0.2
0.2
0.2
0.0
0.1
3.5
1.2
0.0
0.3
0.1
0.0
0.1
0.7
1.7
0.2
0.4
60.4
0.0
0.0
1.1
2.8
0.6
1.3
38.8
0.0
0.0
0.8
2.2
0.2
0.5
0.4
0.0
0.1
1.4
2.2
0.2
1.5
1.1
0.0
0.1
0.4
Number of reported risks
One
Two
Three
None reported
34.1
46.7
13.9
5.3
37.2
44.4
11.9
6.5
38.7
48.9
4.9
7.6
44.6
39.4
7.3
8.7
32.4
47.4
15.5
4.6
42.7
38.6
9.7
9.0
Number WIC participants
4,599
3,278
2,614
1,236
2,424
1,938
NOTES
For PC98, WIC agencies could report up to three nutritional risks for each participant. This table includes all risks reported for every
participant so that column and row percentages sum to more than 100 percent.
30
Abt Associates Inc.
The specific risks that are more prevalent for Native American women off reservations, compared to
those on reservations, are: low hematocrit or hemoglobin (25.8 versus 16.6 percent), prior stillbirth or
miscarriage (7.1 versus 2.3 percent), and general obstetrical risks (48.0 versus 42.5 percent).
Exhibit 17 shows the prevalence of nutrition risks for Native American infants and children on
reservations and off reservations. Native American infants on or near reservations have a greater
number of reported risks than infants off reservations (bottom of Exhib it 17). Infants living on
reservations have higher prevalence of clinical risks (22.2 versus 12.5 percent) and dietary risks (19.2
versus 12.3 percent). Nutrition-related risks are reported for nearly 18 percent of infants on or near
reservations and 9 percent of infants off reservations; inadequate or inappropriate nutrient intake is
reported for 18 percent of infants on reservations and 11 percent of infants off reservations. Infants
off reservations have a slightly higher rate of anthropometric risks compared to infants on
reservations, particularly low weight-for-height, low birthweight or premature birth, and inappropriate
growth; while infants on reservations are more likely to have short stature (7.3 versus 5.5 percent).
Native American children show much the same pattern as infants in risk differences according to
location on or near reservations. Children on or near reservations have higher prevalence of clinical
and dietary risks and lower prevalence of biological risks. An additional difference for children is
that high weight-for-height (overweight status) is reported for 25 percent of children on or near
reservations and for 20 percent of children off reservations. These figures compare to a prevalence
of 16 percent for all WIC participants.
Prevalence of Overweight in WIC Children
The prevalence of overweight among children has become an increasingly important public health
concern. Over the past 30 years, the percentage of overweight children aged 6-17 has doubled
(Troiano and Flegal, 1998). Furthermore, recent research has shown that 60 percent of overweight
5- to 10-year-old children have at least one risk factor for heart disease (Freedman, 1999). The
prevalence of overweight in WIC children is examined in a separate report to FNS, which shows that,
among WIC children, Native Americans have the highest rate of overweight prevalence of all
racial/ethnic groups. 42
Exhibit 18 separately shows the prevalence of overweight among Native American WIC children on
or near reservations and off reservations. Overweight status is identified by measured weight-for42
Cole, Nancy. The Prevalence of Overweight Among WIC Children. July 2001.
Abt Associates Inc.
Characteristics of Native American WIC Participants
31
height or weight-for-length above the 95th percentile of published growth charts.43 These data show
that the difference in prevalence of overweight among Native American children and all WIC
children is largely (although not completely) attributable to different rates of overweight on and off
reservations. Native American children on reservations have overweight prevalence that is 29 percent
greater than overweight prevalence off reservations (20.2 percent overweight versus 15.7 percent
overweight). Compared to all WIC children (13.2 percent overweight), overweight prevalence is 19
percent greater for Native American children residing off reservations and 53 percent greater for
Native American children residing on reservations.
43
32
Weight-for-length is measured for children under age 36 months; weight-for-height is measured for children 36 months
and older. The CDC Revised Growth Charts (released May 2000) were used to determine overweight status.
Prevalence of overweight in Exhibit 18 is below the prevalence indicated by reported nutrition risks due to use of the
revised CDC charts, and also due to use of different overweight standards at different WIC agencies.
Characteristics of Native American WIC Participants
Abt Associates Inc.
Exhibit 17
Prevalence of Reported Nutrition Risks among WIC Infants and Children, 1998
Native American Infants
On or Near
Off
Reservations Reservations
Anthropometric
Low weight-for-height
High weight-for-height
Short stature
Inappropriate growth
Low birthweight/premature birth
Other anthropometric risk
Native American Children
Total WIC
Infants
On or Near
Reservations
Off
Reservations
Total WIC
Children
27.5
1.7
11.0
7.3
2.2
7.1
2.7
28.9
4.5
11.5
5.5
3.5
8.6
4.1
23.7
3.3
4.1
7.0
4.2
9.0
2.8
37.7
2.1
24.8
8.5
5.0
0.3
0.7
36.5
5.1
20.2
8.1
4.1
0.4
7.7
33.6
4.3
15.7
7.7
9.0
0.5
0.9
3.8
3.8
0.0
4.6
4.6
0.0
3.8
3.8
0.0
12.0
12.0
0.0
16.0
15.9
0.1
24.4
24.3
0.2
Clinical Risk
Nutrition-related risks
Substance abuse
Other health risk
22.2
17.6
5.5
4.6
12.5
9.0
4.4
3.7
11.3
3.7
3.9
4.2
29.8
24.8
5.7
5.4
22.5
19.7
4.2
3.3
19.0
9.3
4.1
7.3
Dietary Risk
Inadequate or inappropriate nutrient
intake
Other dietary risk
19.2
12.3
13.2
82.5
77.5
68.3
18.1
1.5
11.4
1.0
9.4
4.2
81.4
3.5
74.3
4.9
64.2
8.1
Other risks
Regression
Transfer (risk is unknown)
Breastfeeding mother/infant dyad
Infant of a WIC-eligible mother
Homelessness/migrancy
Other nutritional risks
84.7
0.2
0.2
28.5
76.9
0.1
0.4
85.7
0.2
0.8
20.6
79.2
0.1
0.4
82.9
0.1
2.2
23.5
73.7
0.1
0.5
3.2
1.3
0.1
0.1
0.3
0.1
1.8
5.5
4.5
0.2
0.1
1.2
0.1
0.7
5.9
3.0
1.4
0.1
0.8
0.1
0.6
Number of reported risks
One
Two
Three
None reported
34.0
38.5
26.2
1.3
45.7
34.5
19.4
0.4
53.0
32.7
13.8
0.5
41.4
42.2
15.3
1.1
43.3
39.1
15.9
1.7
51.7
33.1
14.6
0.6
Number WIC participants
10,082
7,562
2,048,626
27,741
17,082
4,121,017
Biological
Hematocrit/hemoglobin < state std
Other biochemical risk
NOTES
For PC98, WIC agencies could report up to three nutritional risks for each participant. This table includes all risks reported for every
participant so that column and row percentages sum to more than 100 percent.
Abt Associates Inc.
33
Exhibit 18
Percent of Native American WIC Children Measured Overweight, By Age and Gender, 1998
----------------- Native American WIC Children ----------------On or Near
Reservations
Number
Percent
Children Overweight
Off Reservations
Number
Percent
Children Overweight
Total
Number
Percent
Children Overweight
Total WIC
Children
Percent
Overweight
All Children1
Age 1
Age 2
Age 3
Age 4
42,524
12,428
9,742
9,114
7,236
20.2
22.8
21.4
15.9
14.1
22,988
7,604
5,547
4,970
3,495
15.7
20.1
16.2
11.6
10.0
65,512
20,032
15,289
14,084
10,731
18.6
21.8
19.5
14.4
12.7
13.2
15.6
14.2
11.1
9.9
Boys1
Age 1
Age 2
Age 3
Age 4
21,273
6,300
4,873
4,547
3,567
20.4
23.3
20.5
16.0
15.1
11,448
3,753
2,755
2,500
1,734
16.9
22.6
16.1
12.8
10.1
32,720
10,052
7,628
7,047
5,301
19.1
23.0
18.9
14.9
13.5
13.9
17.1
13.9
11.5
10.6
Girls1
Age 1
Age 2
Age 3
Age 4
21,251
6,128
4,869
4,567
3,669
20.0
22.4
22.3
15.7
13.1
11,540
3,851
2,792
2,470
1,761
14.6
17.6
16.3
10.4
9.8
32,791
9,979
7,661
7,037
5,430
18.1
20.5
20.1
13.9
12.0
12.6
14.1
14.4
10.7
9.3
NOTES
Overweight is determined by weight-for-height (age >=24 months) or weight-for-length (age < 24 months) above the 95th
percentile of the Revised CDC Growth Charts (May 2000).
Overweight status could not be determined for 3.6 percent of Native American children and 4.7 percent of all WIC
children due to missing weight, height, or gender information. These children are not reflected in the table.
Total WIC children excludes the U.S. Territories.
1
Children with missing age are included in the totals but are not shown separately. Most of the missing age data are
due to non-reporting of age by Alaska in 1998.
34
Abt Associates Inc.
6.
Conclusion
This report reviews the role of Native American tribes in administering the WIC program and
provides a description of the characteristics of Native American WIC enrollees, comparing Native
American WIC enrollees residing on or near reservations with those residing off reservations.
Native American tribes play a significant role in administering WIC programs at both the State and
local levels. A majority (58 percent) of Native American WIC enrollment is through tribal agencies,
with the greatest Native American WIC enrollment (41 percent) through State WIC agencies operated
by tribal governments. The growth in Native American WIC enrollment dur ing the 1990s, however,
has occurred primarily in Native American enrollment at non-tribal agencies.
WIC enrollment data largely confirm Census reports that there are substantial differences in the
demographic and economic circumstances of Native Americans residing on or near reservations
compared with Native Americans residing off reservations. Native Americans enrolled in WIC on or
near reservations have larger families, rely more on public assistance, and are more highly
concentrated at the lowest levels of poverty.
WIC data add to our knowledge of the health and nutrition status of Native Americans, particularly
with respect to differences in the health status of Native Americans on and off reservations. WIC
enrollees on or near reservations have higher prevalences of anthropometric and nutrition-related
risks than Native Americans off reservations. Native Americans off reservations have higher reported
prevalence of biological risk. It is often cited that Native American children have higher rates of
overweight than other racial or ethnic groups. Native American WIC children, regardless of
residence on reservations, have higher overweight prevalence (based on reported height and weight
data) than all WIC children. On-reservation children have overweight prevalence nearly 30 percent
greater than off-reservation children.
Abt Associates Inc.
Characteristics of Native American WIC Participants
35
References
Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. "The Relation of Overweight to
Cardiovascular Risk Factors Among Children and Adolescents: The Bogalusa Heart Study,"
Pediatrics, 103: 1175-1182, 1999.
Indian Health Service (1998). Regional Differences in Indian Health, 1998-99. U.S. Department of
Health and Human Services, Indian Health Service, Office of Public Health.
Indian Health Service (1997b). Trends in Indian Health, 1997. U.S. Department of Health and
Human Services, Indian Health Service, Office of Public Health.
Indian Health Service, U.S. Public Health Service (2000). American Indian and Alaska Native
population estimates by State for each year 1980 to 2000 (for service and non-service portions of
each State). U.S. Department of Health and Human Services, Indian Health Service, Office of Public
Health, Statistical Database.
Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al. CDC Growth Charts: United States.
Advance data from vital and health statistics; no. 314. Hyattsville, Maryland: National Center for
Health Statistics. 2000.
National Center for Health Statistics, U.S. Department of Health and Human Services (1998b). 1996
Natality Data Set. CD-ROM Series 21, No. 7.
Passel, Jeffrey S. (1996). "The Growing American Indian Population, 1960-19990: Beyond
Demography," Chapter 4 in Changing Numbers, Changing Needs: American Indian Demography and
Public Health. Washington, D.C.: National Academy Press.
Sandefur, Gary D. and Carolyn A. Liebler (1996). "The Demography of American Indian Families,"
Chapter 9 in Changing Numbers, Changing Needs: American Indian Demography and Public Health:
Introduction. Washington, D.C.: National Academy Press.
Sandefur, Gary D., Ronald R. Rindfuss, and Barney Cohen (1996). Changing Numbers, Changing
Needs: American Indian Demography and Public Health: Introduction. Washington, D.C.: National
Academy Press.
Shumway, J. Matthew and Richard H. Jackson. "Native American Population Patterns," The
Geographical Review, April, 1995.
Snipp, C. Matthew (1996). "Size and Distribution of the American Indian Population," Chapter 3 in
Changing Numbers, Changing Needs: American Indian Demography and Public Health .
Washington, D.C.: National Academy Press.
Thornton, Russell (1987). "Tribal history, tribal population, and tribal membership requirements: The
cases of the Eastern Band of Cherokee Indians, the Cherokee Nation of Oklahoma, and the United
Keetoowah Band of Cherokee Indians in Oklahoma. Towards a Quantitative Approach to American
Indian History, Occasional Paper Series No. 8, Chicago Illinois.
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Characteristics of Native American WIC Participants
Abt Associates Inc.
Thornton, Russell (1996). "Tribal Membership Requirements and the Demography of 'Old' and 'New'
Native Americans." Chapter 5 in Changing Numbers, Changing Needs: American Indian
Demography and Public Health. Washington, D.C.: National Academy Press.
Troiano RP, Flegal KM. Overweight children and adolescents: Description, epidemiology, and
demographics. Pediatrics 1998;101:497-504.
U.S. Census Bureau (1994). 1990 Census of Population, Characteristics of American Indians by
Tribe and Language (1990 CP-3-7).
U.S. Census Bureau (1999). Statistical Abstract of the United States: 1999.
U.S. Department of Agriculture, Food and Nutrition Service (1993). Estimates of Persons Income
Eligible for the Special Supplemental Food Program for Women, Infants and Children (WIC) in
1989: National and State Tables. Produced by Sigma One Corporation. August 1993.
U.S. Department of Agriculture, Food and Nutrition Service, Office of Analysis, Nutrition and
Evaluation (2000). WIC Participant and Program Characteristics 1998, WIC-00-PC, by Susan
Bartlett, Melanie Brown-Lyons, Douglas Moore, and Angela Estacion. Alexandria, VA.
Ventura SJ, Martin JA, Curtin SC, Mathews TJ (1998). "Report of Final Natality Statistics, 1996,"
Monthly Vital Statistics Report. Vol 46 no 11, supp. Hyattsville, Maryland: National Center
for Health Statistics.
Abt Associates Inc.
Characteristics of Native American WIC Participants
37
Exhibit A.1
Geographic Jurisdictions of Indian Tribal Organizations Administering State WIC Programs
Number
AIRs
Arizona
ITC-Arizona
Navajo Nation
Colorado
Ute Mountain Ute
Florida
Seminole Tribe
Maine
Indian Township
Pleasant Point
Mississippi
Mississippi Choctaw
Nebraska
NIITDC
Nevada
ITC-Nevada
New Mexico
ACL
Eight Northern Pueblos
Pueblo of Isleta
Pueblo of San Felipe
Five Sandoval Pueblos
Santo Domingo
Pueblo of Zuni
New York
Seneca Nation
North Carolina
Eastern Band-Cherokee
North Dakota
Standing Rock Sioux
Three Affiliated
Oklahoma
ITC-Oklahoma*
Cherokee Nation*
Muscogee Creek Nation*
Otoe-Missouria*
Osage Nation
Citizen-Potawatomi*
Chickasaw Nation*
Sac and Fox Nation*
Choctaw Nation*
WCD (OK)*
South Dakota
Cheyenne River Sioux
Rosebud Sioux
Wyoming
Shoshone-Arapahoe
Total
Land Area
(sq miles)
1990 Population
Native American
Total
Number
Percent
20
1
15,726
24,426
64,284
148,451
55,017
143,507
85.6
96.7
1
901
1,320
1,299
98.4
4
267
2,496
1,411
56.5
1
1
37
1
617
572
542
514
87.8
89.9
1
33
4,073
4,056
99.6
3
658
6,527
5,287
81.0
20
1,973
7,956
4,872
61.2
3
8
1
1
5
1
1
1,299
411
328
79
550
107
654
5,395
8,326
7,510
28,183
2,915
2,434
8,293
3,054
3,517
7,398
5,015
2,723
1,884
4,060
56.6
42.2
98.5
17.8
93.4
77.4
49.0
3
76
2,992
2,721
90.9
1
81
7,412
7,094
95.7
1
1
3,567
1,319
7,046
9,498
5,736
3,047
81.4
32.1
0
0
0
0
1
0
0
0
0
0
16,612
6,700
4,648
278
2,243
1,115
7,304
770
10,612
647
424,011
399,385
635,250
2,775
41,299
91,166
257,858
51,042
209,339
8,195
27,078
66,435
45,190
475
6,100
6,129
21,013
4,575
28,245
599
6.4
16.6
7.1
17.1
14.8
6.7
8.1
9.0
13.5
7.3
1
1
4,265
1,975
7,743
9,696
5,092
7,998
65.8
82.5
1
3,471
21,851
2,485,910
5,717
487,400
26.2
19.6
Approximate total population on all AIRs
Approximate total population of AIRs and TJSAs
438,000
638,000
Notes
Geographic jurisdictions are defined by the American Indian Reservations (AIRs) associated with each Indian Tribal Organization.
* Denotes ITOs in Oklahoma that do not have legally defined reservations; their geographic jurisdiction is measured according
to the Tribal Jursidiction Statistical Area (TJSA) defined U.S. Bureau of Census, for the 1990 census.
38
Abt Associates Inc.
Exhibit A.2
GEOGRAPHIC JURISDICTIONS OF INDIAN TRIBAL ORGANIZATIONS ADMINISTERING
WIC PROGRAMS: East and Southeastern United States
MAINE
Indian Township
Pleasant Point
NEW YORK
Washington County
Erie
Seneca Nation
Cattarau
FLORIDA
Counties:
Glades
Eastern Band Cherokee
NORTH CAROLINA
Hendry
Seminole Tribe
Mississippi Choctaw
Broward
SOUTH CAROLINA
MISSISSIPPI
State boundaries displayed with bold; county boundaries displayed with dotted lines.
Exhibit A.3
GEOGRAPHIC JURISDICTIONS OF INDIAN TRIBAL ORGANIZATIONS ADMINISTERING
WIC PROGRAMS: Mid-West and Western United States
Three Affiliated Tribes
NORTH DAKOTA
MONTANA
Standing Rock Sioux
Cheyenne River Sioux
Shoshone-Arapahoe
OREGON
SOUTH DAKOTA
IDAHO
Rosebud Sioux
WYOMING
NIITDC
NEBRASKA
ITC - Nevada
NEVADA
UTAH
COLORADO
Navajo Nation
Ute Mountain Ute
State boundaries displayed with bold; county boundaries displayed with dotted lines.
KANSAS
Exhibit A.4
GEOGRAPHIC JURISDICTIONS OF INDIAN TRIBAL ORGANIZATIONS ADMINISTERING
WIC PROGRAMS: Southwestern United States
NEBRASKA
KANSAS
COLORADO
UTAH
Ute Mountain Ute
Otoe-Missouria
Cherokee Nation
Osage Nation
OKLAHOMA
Navajo Nation
Eight Northern Tribes
Five Sandoval Pueblos
ITC-Oklahoma
Santo Domingo
Pueblo of San Felipe
Pueblo of Zuni
Pueblo of Isleta
ITC - Arizona
ACL (NM)
WCD
Sac and Fox Nation
Choctaw Nation
Citizen-Potawatomi
Chickasaw Nation
NEW MEXICO
Muscogee Creek Nation
ARIZONA
TEXAS
State boundaries displayed with bold; county boundaries displayed with dotted lines.
With the exception of Osage Nation, tribes in
Oklahoma do not have legally defined
reservations. Areas shown are Tribal
Jursidiction Statistical Areas (TJSAs) as
defined by the U.S. Bureau of Census.